The objective of this research is to assess the quality of the pre-hospital decisions of 81-hour trained emergency medical technicans (EMTs) and 1500-hour trained emergency medical technicians (paramedics) by developing a series of proximal confirmation parameters which are collected in the Emergency Room. Proximal confirmation parameters are diagnostic and/or physiological measurements which will aid in judging the quality of specific pre-hospital diagnostic and/or therapeutic decisions by EMTs and paramedics. In this study, proximal confirmation parameters are being developed for four specific conditions for which interventions exist. These conditions are: peripheral fractures, cardiac arrests chest/abdominal traumas, and suspected myocardial infarctions (MIs). These conditions were selected because they are common, they illustrate four discrete types of confirmation issues in ascending order of methodological complexity, and EMT interventions presently exist or are scheduled for each condition.